激光治疗前后双胎输血综合征供体和受体心肌性能指数及其时间间隔的差异变化

Differential Changes in Myocardial Performance Index and Its Time Intervals in Donors and Recipients of Twin-to-Twin Transfusion Syndrome before and after Laser Therapy.

作者信息

Ortiz Javier U, Torres Ximena, Eixarch Elisenda, Bennasar Mar, Cruz-Lemini Monica, Gómez Olga, Lobmaier Silvia M, Martínez Josep M, Gratacós Eduard, Crispi Fatima

机构信息

BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.

Frauenklinik und Poliklinik, Technische Universität München, Munich, Germany.

出版信息

Fetal Diagn Ther. 2018;44(4):305-310. doi: 10.1159/000485380. Epub 2018 Jan 19.

DOI:10.1159/000485380

PMID:29353282

Abstract

OBJECTIVE

To evaluate left myocardial performance index (MPI) and time intervals in fetuses with twin-to-twin transfusion syndrome (TTTS) before and after laser surgery.

METHODS

Fifty-one fetal pairs with TTTS and 47 uncomplicated monochorionic twin pairs were included. Left ventricular isovolumetric contraction time (ICT), ejection time (ET), and isovolumetric relaxation time (IRT) were measured using conventional Doppler.

RESULTS

Recipients showed prolonged ICT (46 ± 12 vs. 31 ± 8 vs. 30 ± 5 ms; p < 0.001) and IRT (51 ± 9 vs. 43 ± 8 vs. 43 ± 5 ms; p < 0.001) and higher MPI (0.57 ± 0.12 vs. 0.47 ± 0.09 vs. 0.44 ± 0.05; p < 0.001) than donors and controls. Donors showed shorter ET than recipients and controls (157 ± 12 vs. 169 ± 10 vs. 168 ± 10 ms; p < 0.001) and higher MPI than controls (0.47 ± 0.09 vs. 0.44 ± 0.05; p = 0.006). Preoperative MPI changes were observed in all TTTS stages. Time intervals partially improved after surgery.

CONCLUSION

Donor and recipient twins had higher MPI due to different changes in the time intervals, possibly reflecting the state of hypovolemia in the donor and hypervolemia and pressure overload in the recipient.

摘要

目的

评估激光手术前后双胎输血综合征（TTTS）胎儿的左心室心肌性能指数（MPI）和时间间期。

方法

纳入51对患有TTTS的胎儿和47对无并发症的单绒毛膜双胎。使用传统多普勒测量左心室等容收缩时间（ICT）、射血时间（ET）和等容舒张时间（IRT）。

结果

受血儿的ICT（46±12 vs. 31±8 vs. 30±5毫秒；p<0.001）和IRT（51±9 vs. 43±8 vs. 4 + 5毫秒；p<0.001）延长，且MPI高于供血儿和对照组（0.57±0.12 vs. 0.47±0.09 vs. 0.44±0.05；p<0.001）。供血儿的ET短于受血儿和对照组（157±12 vs. 169±10 vs. 168±10毫秒；p<0.001），且MPI高于对照组（0.47±0.09 vs. 0.44±0.05；p = 0.006）。在所有TTTS阶段均观察到术前MPI变化。手术后时间间期部分改善。